Philadelphia Immediate Transport in Penetrating Trauma Trial (PIPT)

A forthcoming research study investigating the survival advantage of immediate transport to the hospital for patients with penetrating torso trauma.

Philadelphia Immediate Transport in Penetrating Trauma trial (PIPT trial) is a research study to determine if prehospital procedures influence survival and other outcomes in patients with gunshot, shotgun or stab wounds to the chest, abdomen or upper arms or legs. The study will include patients with penetrating injury (gunshot, shot gun or stab wounds) transported to the hospital by an advanced life support ambulance crew in the City of Philadelphia.

This study is expected to last at least 5 years.

We are ONLY studying patients who are injured by gunshot, shotgun or stab wound in Philadelphia, have evidence of bleeding, also called hemorrhagic shock and are brought to the hospital by an advanced life support ambulance.

Interventions that might be performed in the field by prehospital personnel include placement of a breathing tube (intubation) and intravenous fluid administration. These procedures can be beneficial in rural settings where it takes a long time to arrive at the hospital. In addition, these procedures can benefit patients with traumatic brain injury. However, the advantage of these field procedures in penetrating trauma patients in urban locations is less convincing.

In fact, studies have shown that prehospital intubation clearly does not confer a survival advantage to penetrating trauma patients in urban locations. Yet prehospital procedures continue to be performed in urban Philadelphia on a regular basis. In a new study published by Temple University, of the 1,615 gunshot and stab wound victims that were highest level trauma activations from 2006-2010, 152 (9.8%) were intubated in the field.

A recent study published by the University of Pennsylvania provides evidence that immediate transport by police does not increase a patient’s chance of dying. In fact, this study suggests that patients who are shot or stabbed and brought to the hospital by Philadelphia police have slightly higher likelihood of survival than patients brought by ambulance.

We are investigating to see if there is a benefit to bringing patients directly to the hospital after they suffer certain injuries. We are directing this investigation at patients who have been shot or stabbed (also called a penetrating injury). After a patient is shot or stabbed they can have blood loss (also called hemorrhagic shock) which leads to a state called shock. There are several modes by which patients may be transported to the hospital after such an injury. One method is called advanced life support (ALS). The ALS standard is for emergency medical personnel to place intravenous catheters (also called IVs) and start salt water (intravenous fluid) on the way to the hospital if they are deemed to be necessary. ALS might also include the placement of a breathing tube (also called an endotracheal tube) if the patient who has been shot or stabbed is not awake or breathing on their own. A second mode of transport is called basic life support (BLS). BLS providers do not place IV catheters or place a breathing tube for any patients. A third mode of transport in the City of Philadelphia is by police transport. There are certain situations in which Philadelphia police officers will transport very sick injured patients to the hospital and do not provide any medical care.

We are ONLY studying patients who are injured by gunshot, shotgun or stab wound in Philadelphia, have evidence of bleeding, also called hemorrhagic shock and are brought to the hospital by an advanced life support ambulance.

Patients in this study will be enrolled into one of two groups. The first group will get standard advanced life support therapy on the way to the hospital which might include IV fluids or breathing tube placement. The second group will be brought immediately to the hospital and get basic life support therapy on the way to the hospital. They will not have IVs placed and will not be given IV fluids on the way to the hospital. This group will not have a breathing tube placed, but will be given oxygen by a face-mask on the way to the hospital if it is needed.

Any patient with gunshot, shotgun or stab wounds to the head or neck, or who does not have a gunshot, shotgun or stab wound to the chest, abdomen or upper arms or legs, will not be included in this study. Additionally, any patient who is known to be less than 18 years old, pregnant or a prisoner will not be included in this study. Finally, any patient who has a normal heart rate, normal blood pressure and is awake and alert will not be included in this study.

Once a patient included in the study arrives at the hospital, all care provided will be standard care regardless of the group. Enrollment in the study only changes whether a patient receives prehospital procedures or no prehospital procedures.

We believe that this study will prove that for patients with gunshot, shotgun and stab wounds to the chest, abdomen and upper arms or legs who have evidence of active bleeding, immediate transportation to the hospital with no prehospital intubation or IV fluids will improve the chance of survival. If this is true it will improve the way we take care of these patients around the country.

This study includes an exception from informed consent. This means that patients will be unable to provide consent at the time they enter into the trial. However, patients who are included in the study will be approached within 24 hours of entering the study to complete a formal consent process. If a patient is unable to consent at this time, family will be approached to discuss continued participation.

If you do not wish to be a study subject in this trial, simply fill in the OPT OUT form by clicking the link below. You will then be mailed a wristband.

The study will be taking place in the City of Philadelphia for at least 5 years. If you do not want to be included in the study you must wear the wristband for at least 5 years. If you do not wear the wristband and are injured by gunshot, shotgun or stab wound you may be included in the trial.